The disease of addiction

Wednesday

Dr. Mark C. Wallen has been the medical director of the Livengrin Foundation for the past 12 years. He is board certified in psychiatry, addiction psychiatry and addiction medicine.

Q. Many parents, upon discovering that their child is addicted, express frustration that he or she cannot just “knock it off.” Can you explain how addiction becomes a physical dependence, not just a matter of will:

A. There is both a difference and correlation between a physical dependence and the biological changes that are the core foundation of chemical dependency disorders. As a person uses a substance, be it alcohol or certain drugs, over a period of time they are loading their brain cells with the substances. As a result, biochemical changes begin to take place inside the cells. Those changes can be the foundation for chemical dependency disorders. There are a number of symptoms; the hallmark is the compulsive craving to use.

Q. Can you describe this compulsive craving?

A. This craving is extremely intense, and can be perceived by the person as removing the sense of having a choice. It takes on an instinctive quality to it — that the brain must have the chemical just to function normally. The user develops a perception internally that they can suffer or die without the chemical — just like breathing, eating, etc.

We don’t remark to ourselves, “Well, if I don’t eat, I’ll die.” It’s just there, it’s a part of our human makeup. Cravings can really be that strong and overpowering.

Q. Is there a misconception that one trip to a rehab clinic will “work?” Do you have any statistics that show just how frequent a heroin addict goes to rehab?

A. Addiction is a chronic disease. Once the disease has developed, it can be viewed in ways similar to how we look at hypertension, asthma or diabetes. One trip to a rehab clinic or treatment setting is just the initiation of care for a lifelong illness.

People don’t become cured, but have to undertake a lifelong process of “managing” the disease so that a return to use of the drug does not occur. In the case of addiction, it’s about learning relapse-prevention techniques. There are so many things that come into play — continuing involvement with treatment professionals, support groups and relationships. The central key is lifestyle changes.

Q. People say addiction is a lifelong battle. Why?

A. As with any chronic medical condition, a person must address this on a lifelong basis. One must be on the alert for warning signs that they might be putting themselves at risk for relapsing. What doesn’t go away is a underlying brain sensitization process that stays with the person for life because, simply, that’s how our brain and body work. Once you develop the disease, you have it.

Q. What is the danger in relapsing after a longer stretch of staying clean?

A. Physical dependence can involve developing a tolerance to the effects and possible toxic reactions to substances. In the case of opiates, as an example, once the person stops using for a period of time they lose their tolerance to the opiates. If they try to use once again at the amount they had previously been using prior to stopping usage (i.e. by being involved in treatment), this can result in an overdose because the brain and body cannot handle it.

Many people think they can experiment with substances once they have initially completed treatment, to test themselves by trying a small amount of substance. But once they get the chemical back into the system, this activates the compulsive craving and the person then tends to rapidly return to their prior previous pattern of usage.

Q. Describe why the risk is greater.

A. So the person who uses the drug again at the previous high level “just one time” can end up in an overdose. Hitting that high mark again is very disturbing to the body, and it can be fatal. For a return at a smaller level, this leads to the brain re-activating the craving, and that in itself usually leads to continued progressive use. Relapse with any drug leads to the return of the low-functioning state. There is no such thing as saying, ‘I know I was off drugs, but just this one time for the party won’t hurt me because I’m clean now’.

Q. What do you think most people don’t understand that could put addiction in perspective for the average person?

A. A basic truth that has to be accepted by the patient and also, especially, the people around them — the family, employers, friends — is that it’s a biological disease, not just a lack of morals or low will power. As a biological illness, it has to be addressed from a medical perspective, with well-identified and successful treatment approaches.

Q. Is there any context you can provide on why heroin is such a natural progression after OxyContin use?

A. This situation in society is coming about primarily because heroin is cheaper and more available for misuse than prescription drugs. OxyContin and other prescription opiates can be available in a parents’ medicine cabinet, or may be passed around between young people because someone got their hands on it. As time goes on and a person’s usage begins to escalate, it becomes increasingly expensive.

Once heroin use begins, many individuals find the euphoria to be at a more intense level than they might have gotten with the pills that preceded it. They perceive the heroin high as more rapid, intense and pleasurable — which promotes ongoing utilization of it.

Many preparations of OxyContin have been taken off the market in the U.S. Abusers have therefore switched to other opiate medications (i.e. Percocet), which contain the same active ingredient as OxyContin (oxycodone). Vicodin (which contains the opiate hydrocodone) is another commonly abused opiate painkiller.

Q. Are some people more predisposed to addiction?

A. Some people may be genetically predisposed to attaining a greater high from the agent as compared to other people. This phenomenon can affect anyone, with any kind of drug or alcohol. This is why a person who is genetically predisposed can become addicted very quickly after a long binge with drinking, even though they’d hardly ever touched alcohol previously. Or someone taking prescription pills for a few months to recover from back pain after an accident realizes not only that they like how the drug makes them feel; now they’ve developed a sense that they must have the drug to get through the day just to feel normal.

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